Provider Demographics
NPI:1942276720
Name:LAKANEN, HEIDI M (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:LAKANEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W. WHITE RIVER BLVD.
Mailing Address - Street 2:RCS PROVIDER ENROLLMENT: ATTN-DAWN HAMAKER
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:1809 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:IN
Practice Address - Zip Code:46989-9242
Practice Address - Country:US
Practice Address - Phone:765-998-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200101500Medicaid
INP00720113OtherRR MEDICARE PTAN
INP00968548OtherRR MEDICARE
INP00968548OtherRAILROAD MEDICARE
INF85689Medicare UPIN
INM22404005Medicare PIN
INM400025550Medicare PIN